Managed Care, Profits & Care Quality

Managed care programs are increasing in number with the goals of controlling health care costs and continuing to provide quality care. Questions exist, however, regarding the maintenance of quality assurance. The issue of managed care and care quality is examined in this research. The specific question addressed in this research is as follows: "Have we sacrificed our health care quality for the bottom line?" The position of this researcher is that the quality of care in the United States has been sacrificed for profitability in the managed care system.

Managed Care and the Evolving Health Care Environment

Changing social structures are leading to evolving approaches to the delivery of health care. The roles of the various professional providers of health care also are in a state of transition. Societal changes also are occurring that impact the ethical bases of the functioning of health care delivery systems. Managed care is an evolving approach to the delivery of health care that affects each of these other factors (MacStravic, 1996).

Reform of the health care system in the United States is a volatile issue. Costs are the primary concern of funding providers, while a continuation of the opportunity to earn profits is the primary concern of the health insurance industry, and increased access to health care services is the primary concern of social activists. Managed care has been proposed as the concept that can satisfy e

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time expended by health care providers in negotiating contracts with managed care organizations will translated into less time for providers to spend with patients, and a consequent deterioration of the quality of care delivered. Changes in the health care system likely will be constant in the future. Contracts will involve financial and legal aspects. Small-group practices will face particularly intense challenges, while larger group practices may be necessary to meet the demands of managed care organizations. Larger group practices will further remove providers from close relationships with patients, which in turn will have an adverse impact on the quality of care delivered (Sunshine & Evens, 1994). Nurse care models are changing with the advent of managed care. Many nurse leaders believe that controlling costs is more important than maximum reimbursement for tasks. With this priority, care models will be focused on effectiveness and efficiency to support competitive pricing, which in turn will lead to a further deterioration in the quality of care delivered to patients (Girard, 1993). The Timberlawn Mental Health System in Dallas was required to close its psychiatric residency program because of financial stress (Mitka

Category: Medical - M